How can I reduce irritable back pain?

When should I worry about back pain in pregnancy?

Contact your GP or midwife urgently if you:

• are in your second or third trimester and have back pain - it could be a sign of early labour
• have a high temperature, bleeding from your vagina or pain when you wee
• have pain in one or more of your sides (under your ribs). This could be a sign of pre-eclampsia.

Call 999 or go to A&E if you have back pain and you lose feeling in one or both of your legs, your bum, or your genitals.

Why do I have back pain?

During pregnancy your ligaments loosen up and stretch to get your body ready for labour. This puts strain on your joints, which can cause back pain.

Pregnancy also affects your posture (the way you hold your body up while standing or sitting). When you’re pregnant, the natural curve in your spine increases because it’s trying to cope with the extra weight of your baby bump. This can cause pain.  

Many women and birthing people say the pain is worse in the evening and after 28 weeks of pregnancy (third trimester).

Some women and birthing people with lower back ache also have pelvic girdle pain (also known as symphysis pubis dysfunction). This is caused by stiffness in the pelvic joints.

Back problems can affect your sleep and make it harder to go about your everyday life. But there are a few things you can do to help ease the pain.

Exercise

If you have back pain it’s tempting to lie down as much as possible. Rest is important during pregnancy. But lying down for long periods of time is not recommended when you have a bad back. It is generally better to stay active and exercise as best you can.  

Low-impact exercises such as pilates and yoga can help build your muscles to better support your back and improve your posture, flexibility and balance. These types of exercises can help you take care of your mental health during pregnancy too, reducing stress and anxiety.

If you choose a class, make sure the teacher is qualified and tell them how many weeks pregnant you are. It is best to choose a class that’s for pregnant people.  

You may also find exercising in water helpful because the water will support your weight. You could try swimming, or an aquanatal class. Contact your local leisure centre to find out what they offer.  

Some hospitals offer exercise classes to pregnant women being cared for by their maternity team. Ask your midwife what’s available.  

Pain relief

You can take paracetamol to ease back pain while you are pregnant, unless your GP or midwife says not to. It is safe to take paracetamol in pregnancy, but it’s best to check with your midwife or GP first. If you take it make sure you:

• follow the instructions on the packet for how much you can take
• try to take the lowest dose that works and for the shortest amount of time.

Ibuprofen is not usually recommended in pregnancy, unless it's prescribed by a doctor, especially if you're more than 20 weeks pregnant. This includes ibuprofen tablets and many over-the-counter back and muscle relaxant creams, such as Deep Heat.  

Speak to your doctor or midwife before taking ibuprofen or any other kind of non-steroidal anti-inflammatory drugs (NSAIDs).

Find out more about medicines in pregnancy.

Physiotherapy

Talk to your GP or midwife if your back ache is very painful. They may be able to refer you to an obstetric physiotherapist, who can give you advice. You can also pay for private physiotherapy, although this can be expensive.

Heat packs

It is safe to use a heating pad or water bottle on your back during pregnancy to ease lower back pain. Do not use these on your stomach (abdomen).

Try to use heat packs or water bottles for a short amount of time. Most people feel warmer than usual during pregnancy due hormone changes and increased blood supply to the skin, so it is easier to overheat.

Think about your posture

When standing up

The way that you stand can make a big difference during pregnancy. Try not to stand in the same position for too long. Stand tall, and keep your bottom gently tucked under.

• Keep your head lifted up with your ears in line with your neck  
• Relax your shoulders back and down
• Try not to slack your back muscles and tilt your pelvis forward.
• Try to slightly bend your knees to ease your body weight.

When sitting down

Try not to slump when you’re sitting on the sofa. Use cushions to support your back and have your feet resting on the floor. It may help to lie on your side if you are watching TV or relaxing. Using a birthing ball may also help. A birth ball is a slightly larger version of a gym ball that you can use to exercise, sit comfortably and practise positions for labour. Find out more about using a birth ball.

If you work in an office, the top of your computer screen should be set up just below eye level. Your keyboard should be at a comfortable height so your forearms are flat. Try to get up and move around regularly so you don’t get stiff. It may be helpful to ask for an occupational health assessment if you are an employee.

Tips for getting in and out of bed with back pain

Try to avoid lying flat for long periods of time. It’s better for your back and your baby to lie on your side, especially after 28 weeks of pregnancy (the third trimester) as this can help prevent stillbirth. Find out more about safe sleep in your third trimester.

You may find it more comfortable to have a pillow under your bump or between your knees to support your back. This can help you sleep better, too.  

Some women find pregnancy pillows can help, but they can be pricey. You may find a normal pillow does the trick.  

If you are getting pain in your hip from lying on your side, it may help to place a duvet under your sheet or use a memory-foam mattress topper.  

Getting in and out of bed can get more difficult as your bump gets bigger. To take the strain off your back, try rolling onto your side moving your shoulders, hips and knees at the same time. Let your legs ease off the edge of the bed and put your feet on the floor. At the same time, use your arms to push yourself up to a sitting position.

Doing this all as one movement can be more comfortable. Try the movement backwards to get back into bed.  

Massage therapy

You may find massages help with back ache. It’s also a great way to have some quiet time to yourself and relieve any emotional stress or anxiety during pregnancy.

There is no evidence that having a massage in the first 12 weeks (first trimester) causes miscarriage. But it is still important to tell your massage therapist that you are pregnant and how far along you are throughout your pregnancy. They should avoid massaging your stomach (abdomen).

It is best to have a massage that’s specifically for pregnant women and birthing people.  

Acupuncture

Acupuncture is a type of complementary therapy that involves a practitioner inserting thin needles at particular points on your body. It’s used to control and relieve pain. Research has shown that it can help with back ache for pregnant women.

Acupuncture is generally safe to have when you’re pregnant but talk to your midwife or GP before you book a session. If you do want to try it, make sure your acupuncturist is fully qualified and that they use disposable needles at every treatment session. Tell your practitioner that you’re pregnant because certain acupuncture points cannot be used safely in pregnancy. 

Some NHS doctors and physiotherapists can give acupuncture alongside regular medical treatment. Talk to your GP or midwife to find out more. Most people pay privately for acupuncture.

More useful tips for reducing back pain

• Bend your knees and keep your back straight when you lift or pick something up from the floor
• Avoid lifting heavy objects
• Move your feet when you turn to avoid twisting your spine
• Wear flat shoes to evenly distribute your weight
• Try to balance the weight between 2 bags when carrying shopping
• Use a mattress that supports you properly – you can put a piece of hardboard under a soft Mattress to make it firmer, if necessary.

More support and information

Acupuncture Associated of Chartered Physiotherapists is a professional network for physiotherapists who also do acupuncture.

British Acupuncture Council is a self-regulating body for the practice of traditional acupuncture in the UK.  

British Medical Acupuncture Society is a charity where members are regulated healthcare professionals who do acupuncture.

Chartered Society of Physiotherapy is a recognised professional body with details of registered private physiotherapists.

The Council for Soft Tissue Therapies is the governing body for massage therapies in the UK with details of qualified practitioners.